NPIMap

Organization Active NPI

Amg-Crockett, LLC

Doing business as Advanced Neurology Associates

  • Neurology Physician
  • Lawrenceburg, TN
National Provider Identifier
1043475700
Registry record updated May 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
38839 Issued in TN
Legal business name
AMG-CROCKETT, LLC
Doing business as
Advanced Neurology Associates
Practice address
1605 S Locust Ave
Suite 103
Lawrenceburg, TN 38464-4053
Phone
(931) 762-6571
Fax
(931) 762-3339
NPI assigned
Jul 22, 2008
Last updated
May 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Clark
Title
Division President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 38839 TN Primary

Addresses

Primary practice location

1605 S Locust Ave
Suite 103
Lawrenceburg, TN 38464-4053

Mailing address

PO Box 248
Lawrenceburg, TN 38464-0248
Phone (931) 762-6571

Other names 1

  • ADVANCED NEUROLOGY ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071017000313 TN Part B Supplier - Clinic/Group Practice 4789770199 Receives reassigned benefits from 92 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

Locations

184 Prosser Rd
Lawrenceburg, TN 38464
Phone (931) 762-1800

1255 E College St
Ste 300
Pulaski, TN 38478
Phone (615) 771-6899

200 Hillside Dr
Pulaski, TN 38478
Phone (931) 363-3514

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1043475700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384640248",
            "telephone_number": "931-762-6571",
            "fax_number": "931-762-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 S LOCUST AVE",
            "address_2": "SUITE 103",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644053",
            "telephone_number": "931-762-6571",
            "fax_number": "931-762-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-CROCKETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIVISION PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "38839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED NEUROLOGY ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.